Community health workers fill gap between health care system and ‘where life happens’ 

The trust that community health workers build in the neighborhoods they serve enables them to help individuals transform their health through evidence-based, lifestyle behavior changes. ACLM has launched a training program to help community health workers and similar front-line health workers apply the six pillars of lifestyle medicine.

Sabrina Falquier, MD, CCMS, DipABLM, learned the importance of community growing up in Mexico City. Born to a Swiss father and an American mother, her first language was Spanish, and she embraced the rich culture–food, music and loyalty to community and family–that shaped and connected the people living around her. 

That’s why later, as a lifestyle medicine board-certified physician caring for largely Hispanic populations in Southern California, she found a disconnect between the sterile exam rooms where clinicians engage patients in conversations about healthy lifestyle behaviors and patients’ communities where they live, work and play. 

“What is often missing is a bridge between what happens inside the health care system and individuals’ communities where life happens,” she said. “I can give a patient with heart disease cardiac-healthy recipes but if the recipes do not resonate with their cultural foods and palate, or if the ingredients aren’t available in their grocery stores, the change in eating pattern is not likely sustainable. However, if they learn to cook those recipes with familiar herbs and spices and ingredients that are already familiar and then eat the prepared dishes with their family and community, they are more likely to sustain the changes.” 

Dr. Falquier believes that a key to filling this gap is the utilization of the community health worker (CHW). Dr. Falquier is a contributor to the American College of Lifestyle Medicine’s (ACLM) new three-hour online Community Health Worker Training designed to empower CHWs and other community-facing health workers with practical lifestyle medicine tools and resources to guide individuals and communities toward a healthier lifestyle. The course is available in English and Spanish versions.  

What is a community health worker? 

CHWs are frontline public health workers who are trusted members of the community they serve. They act as a liaison between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery, according to the American Public Health Association. CHWs may connect with individuals through home visits, group sessions, and community outreach, creating supportive environments for individuals to take charge of their health. 

There are more than 60,000 CHWs in the U.S., with a job growth outlook of 13%. The U.S. Bureau of Labor Statistics characterizes this as much faster growth than the average of other occupations.  

The role of lifestyle medicine in reducing chronic disease 

The U.S. chronic disease crisis is unsustainable. An estimated 129 million people have at least 1 major chronic disease. A growing number of people have multiple chronic conditions (42% have two or more, and 12% have at least five). More than 40% of school-aged children and adolescents have at least one chronic health condition. While genetics may predispose individuals to certain diseases, unhealthy nutrition, physical activity, sleep and stress management behaviors contribute to disease at a greater rate. Medically underserved communities often face higher rates of chronic disease.  

Lifestyle medicine is a medical specialty that uses therapeutic, evidence-based lifestyle interventions as a primary modality to treat, reverse and prevent chronic conditions. Lifestyle medicine applies six pillars of medicine—a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, positive social connections, and avoidance of risky substances. 

How community health workers address lifestyle behaviors 

A deep understanding of the communities they serve makes CHWs uniquely positioned to help individuals develop and sustain healthy lifestyle behaviors. CHWs build rapport with community members, help make health messages relatable and transcribe medical advice into everyday actions. 

Dr. Falquier’s understanding of the potential of CHWs grew from her experience working with Olivewood Gardens and Learning Center, a non-profit with a teaching kitchen, located near the Mexican border. There, she learned that presentations to all the schools in the community were less impactful if she, as a physician, delivered the information. The information resonated more deeply when presented by local graduates of the teaching kitchen’s eight-week program which includes many of the pillars of lifestyle medicine: learning to shop for and prepare culturally appropriate and nutrient dense plant-predominant meals, community building, mindfulness and the importance of physical activity. Whereas a physician is often perceived as separate and detached from the community group, the graduates—known as kitchenistas–are accepted and trusted as members of the community.   

“A simple example: nacho fundraisers are big in schools – everyone tends to love them, and they are profitable,” she said. “Not very nutritious, the way they are traditionally prepared. Yet instead of being told to stop doing nacho fundraisers, they were taught to use cashew cream, add chopped vegetables and bake cut tortillas into chips. They were empowered, by their peers, to understand why they were doing it, and through a cooking demonstration and tasting, could see how to prepare them and how delicious they were.” 

Applying all six pillars  

The ability of CHWs to impact lifestyle behavior extends beyond the pillar of optimal nutrition.  CHWs can help individuals develop plans and overcome obstacles for increased physical activity and positive social connections, Dr. Falquier said. The CHWs’ familiarity with the community allows them to identify safe spaces for physical activity, help organize ride shares for shopping for and sharing of nutrient-dense ingredients in bulk and develop opportunities to reduce feelings of isolation.  

“Community health workers are built into the fabric of the community – that’s the beauty of this,” she said. “Their kids go to the same schools; they see each other at grocery stores and at neighborhood gatherings. We have an incredible opportunity to harness all these advantages by preparing these incredibly valuable health workers to help people transform and restore their health through lifestyle behavior change.” 

The community health worker course 

ACLM’s Community Health Worker Training features three hours of online educational presentations designed specifically to help support CHWs in guiding individuals toward healthy behaviors that align with the pillars of lifestyle medicine. Key features include evidence-based tools, such as checklists outlining optimal conditions for each pillar, actionable suggestions and referral indicators, as well as complementary guides, handouts, and tools for sustained engagement and support. 

Although the training was designed for CHWs, the training is applicable for a wide range of community-facing healthcare professionals, including home health aides, public health workers, and patient navigators. The training is available to individuals and to organizations through lifestyle medicine organizational training packages, which health systems are increasingly utilizing to multiply the impact of incorporating evidence-based lifestyle medicine.  

For information about training packages tailored to your organization’s needs, contact ACLM Director of Partnerships Chelsey Hoffman at partnerships@lifestylemedicine.org.